Key result
Patients eligible for primary prevention ICD therapy who did not receive it prior to experiencing sudden cardiac arrest incurred a mean total medical cost of US $11,679.
Why the study?
In Japan, primary prevention ICD therapy is not covered by insurance reimbursement leading to underuse, prompting an analysis of medical costs incurred due to lack of primary prevention ICD therapy.
Cohort (n=43)
Yes
The underutilization of primary prevention ICDs in eligible patients in Japan is associated with substantial post-arrest medical costs and poor clinical outcomes.
Highlights costs from primary prevention ICD underuse in Japan; hypothesis-generating for reimbursement policy effects.
BACKGROUND: In Japan, the implantation of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) is not covered by insurance reimbursement, and the underuse of ICDs has been noted. Therefore, this study analyzed the medical costs incurred due to a lack of primary prevention ICD therapy for SCD. METHODS AND RESULTS: This retrospective cohort study analyzed data from 4 advanced critical care centers between January 2020 and December 2024. From a database of 3,606 cases of cardiac arrest, there were 348 patients with a documented rhythm at the time of arrest that could have been treated with an ICD. Of these patients, 43 (12.4%) had documented evidence of heart failure treatment and were eligible for ICD implantation before experiencing a cardiac arrest. The total mean (±SD) medical cost for these patients was US $11,679±14,666 (¥1,775,150±2,229,272). CONCLUSIONS: In this multicenter retrospective analysis, we identified a subset of patients who were eligible for primary prevention ICD therapy but did not receive it prior to experiencing sudden cardiac arrest. These cases were associated with substantial post-arrest medical costs. Our findings highlight the potential clinical and economic impact of the underutilization of ICDs in Japan and suggest that broader implementation of guideline-directed ICD therapy for primary prevention may reduce both mortality and healthcare expenditure.
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Kondo et al. (2025) conducted a cohort in Out-of-hospital cardiac arrest with pre-arrest ICD indication (n=43). Lack of primary prevention ICD therapy was evaluated on Total mean medical cost. Patients eligible for primary prevention ICD therapy who did not receive it prior to experiencing sudden cardiac arrest incurred a mean total medical cost of US $11,679.
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